Is enhanced recovery after surgery essential?

BACKGROUND: The enhanced recovery after surgery (ERAS) method is designed for the patient to recover quickly, have less pain and have a more comfortable period after the surgery; that includes preoperative, intra and postoperative processes. ERAS has been started to be applied in cesarean section surgeries as the patients need to recover quickly. In the literature, there is no study about the results of ERAS in cesarean section about pain scores and complications. OBJECTIVES: It is aimed to compare the results of cesarean section patients using the ERAS method completely in patients who have had cesarean section without meeting some of the postoperative conditions of the ERAS criteria. STUDY DESIGN: It is a prospective study designed as postoperative metoclopramide, enema and routine opioids in group 1, enema and metoclopramide in group 2, metoclopramide only in group 3 and nothing in group 4. Postoperative pain scoring was done by using visual analog scale (VAS). Analysis of variance tests and t tests were used for results. RESULTS: There was no difference between groups according to age, parity, and birth weight. As a result, although there was no difference between the groups in terms of discharge time and complications, the VAS score used in pain scoring was found to be significantly lower in group 3 compared to the other groups (p: 0.000). Only metoclopramide group (group 3) had lowest VAS score. CONCLUSION: It has been revealed that the ERAS procedure does not need to be so detailed in the postoperative period, and the addition of metoclopramide may be sufficient. Since pain can be a subjective factor, other randomized studies are needed in terms of other criteria.

Neutrophil/Lymphocyte and Platelet/Lymphocyte Ratio in Preterm Premature Rupture of Membranes.

AIM: This study aimed to investigate maternal hematological laboratory parameters of pregnancies complicated with preterm premature rupture of membranes (PPROM) compared to mothers of healthy-term infants (control group). MATERIALS AND METHODS: This case-control study included 158 mothers who were divided into PPROM (n=67) and control (n=91) groups, respectively. Laboratory parameters of platelet, lymphocyte, and neutrophil counts, neutrophil/lymphocyte ratio (NLR), and platelet/lymphocyte ratio (PLR) were recorded at the time of diagnosis for the PPROM group and at the time of hospital admission for birth for the control group. RESULTS: NLR was significantly higher in the PPROM group than in the control group (p=0.001). The cutoff value of NLR to predict PPROM was 6.73 (AUC=0.671, 95% confidence interval=0.58-0.75, p=0.000). CONCLUSION: A cheap and routine NLR blood test can be used to predict PPROM before labor.

Results of Endometrial Sampling in a Tertiary Hospital.

AIM: This study aims to investigate the results of endometrial sampling in a tertiary hospital according to age and symptoms. MATERIALS AND METHODS: A total of 505 patients who underwent endometrial sampling due to various reasons in our tertiary hospital in the last six months were included in our study, and the pathological results of endometrial sampling were analyzed retrospectively. RESULTS: The mean age of 505 patients was 45.03 + 7.40 (19-74) years, and 91.5% of the indications were premenopausal abnormal uterine bleeding and 8.5% were postmenopausal bleeding. The most common pathological result of all age groups was proliferative endometrium (37.6%), and the least was the endometrial intraepithelial neoplasia (0.2%). In 9.3% of patients, the result was insufficient material. Of the patients, 88.7% had no additional organic pathology. A total of 30 (5.9%) patients have undergone surgery after endometrial sampling. CONCLUSION: It should be kept in mind that despite the pathological result may be insufficient rarely, endometrial sampling should be performed as the first choice in abnormal uterine bleeding.

Evaluation of Nrg4 and thiol/disulfide homeostasis in patients with GDM.

BACKGROUND: In this study, we aimed to evaluate the role of neuregulin4 (Nrg4) in the etiopathogenesis of gestational diabetes mellitus (GDM) and thiol/disulfide homeostasis as an indicator of oxidative stress. METHODS: This prospective, case-control study included 34 women with diabetes and 34 healthy pregnant women who applied between January 2017 and January 2020. Levels of native and total thiol, disulfide and Nrg4 were measured in both diabetes mellitus and healthy pregnant groups. RESULTS: When compared to the control group, the serum neuregulin4 levels in the diabetes group were considerably lower (3.22 ± 2.16 vs. 4.55 ± 0.96, p < 0.001). Native thiol (292.67 ± 43.65 vs. 366.40 ± 51.28; p < 0.001), total thiol (388.60 ± 46.60 vs. 414.52 ± 54.19; p < 0.001) levels and native thiol/total thiol ratio (75.51 ± 8.95 vs. 88.35 ± 3.54; p < 0.001) were lower in diabetes group compared to control group. Disulfide level (47.96 ± 19.52 vs. 24.06 ± 7.69) and disulfide/native thiol (17.13 ± 8.03, vs. 6.67 ± 2.30) and disulfide/total thiol (12.24 ± 4.47 vs. 5.82 ± 1.77) ratios were higher in diabetes group (all p < 0.001). CONCLUSIONS: We suggested that decreased Nrg4 level and impaired oxidative stress parameters may be related with the increased risk of diabetes. However, we did not found a correlation between the Nrg4 and oxidative stress parameters.

Predicting asphyxia in term fetus.

This aim of this study was to investigate maternal hematological laboratory parameters of term infants before birth diagnosed with asphyxia compared to mothers of healthy term infants and predict asphyxia by these parameters. This study was conducted on 109 and 192 mothers of the fetus with asphyxia and healthy, respectively. Laboratory parameters of complete blood count, including PDW (platelet distribution width), PCT (procalcitonin) and NLR (neutrophil/lymphocyte ratio), were recorded before birth from pregnant women. PDW and basophil counts were significantly higher in the asphyxia group than healthy group (p: .000). The cut-off level of 19.425 accurately predicted the occurrence of asphyxia (AUC = 0.724 (95% confidence interval 0.65-0.78), p = .000). Basophil count could predict asphyxia, especially the cut-off level of> 0.15(10³/µL) (AUC = 0.67) (95% confidence interval 0.60-0.74, p = .000). To predict asphyxia before labor, a cheap and routine test of PDW can be used after more research in this area.IMPACT STATEMENTWhat is already known on this subject? Asphyxia is still an unsolved problem in neonatal mortality and morbidity, and it is seen in babies of mothers who carry some risks during pregnancy (such as multiple pregnancy, baby of mother with preeclampsia, meconium aspiration, diabetes); however, it is known that it is a subject that is still not fully understood as it can also occur as a result of labor that does not have any risk factors and goes well.What do the results of this study add? In term fetuses without risk factors, it can be predicted to a certain extent whether the fetus will be diagnosed with asphyxia from the hemogram test that can work from the blood of the mother before birth.What are the implications of these findings for clinical practice and/or further research? In clinical practice, asphyxia can be estimated with a cheap and simple test, without any extra examination, by looking at the routine blood tests taken from the mother before going into labor.

An incidental finding of chronic salpingitis complications: Tubo-uterine fistula.

OBJECTIVE: Pelvic inflammatory disease (PID) is an infection of the upper genital tract in women that can include endometritis, parametritis, salpingitis, oophoritis, tubo-ovarian abscess, and peritonitis. The spectrum of the disease ranges from subclinical and asymptomatic infection to severe, lifethreatening illness; squealae include chronic pelvic pain, ectopic pregnancy, and infertility. In this case we report an uncommon complication of pelvic inflammatory disease, a tubo-uterian fistula. Our case was diagnosed by laparoscopy incidentally during assessment of infertility.

Evaluation of time lapse for establishing distal tubal occlusion diagnosis during hysterosalpingography procedure performed by using water soluble contrast media.

BACKGROUND: Hysterosalpingography (HSG) is the most frequently used diagnostic measure for simultaneously determining uterine abnormalities and tubal status among subfertile women. Despite several broader advantages such as availability and increased experience, the subjectivity involved during administration of the HSG procedure itself, and necessary imaging review, decreases the reliability and accuracy of HSG. In this study, we evaluated the time intervals between X-ray imaging during HSG procedure to establish the presence of distal tubal occlusion. METHODS: Our study evaluated the HSG records of 89 women who underwent diagnostic laparoscopy for infertility work-up. Patients who were diagnosed with distal tubal occlusion upon receiving HSG and patients who demonstrated tubal patency on HSG were included in the study, to compare the time intervals in seconds from the tubal visualization view to the last fluoroscopic X-ray shot during the HSG procedure with tubal patency on diagnostic laparoscopy. RESULTS: A statistically significant correlation regarding tubal patency between HSG procedures and diagnostic laparoscopy chromopertubation procedures was demonstrated. Although nearly statistically significant, the interval in seconds between the first HSG imaging and distal tubal filling was shorter for patients with patent tubes on diagnostic laparoscopy than patients with bilateral tubal occlusion (8.4±31.9 and 12.0±19.7, respectively; p=0.057). Time period intervals between the first and the last HSG, and between distal tubal filling to the last HSG of patients with patent tubes on diagnostic laparoscopy and patients with bilateral distal tubal occlusion were found to be statistically similar. CONCLUSION: Although a trend exists towards shorter time period intervals between the first uterine visualization and distal tubal filling graphy among patients with tubal patency, rather than patients with distal tubal occlusion confirmed by diagnostic laparoscopy, clinically reliable objective time period intervals for finalizing the HSG procedure and proceeding with diagnostic laparoscopy due to distal tubal occlusion diagnosis on HSG could not be detected.

Doppler Assessment of the Aortic Isthmus in Intrauterine Growth-Restricted Fetuses.

We aimed to evaluate the association of fetal aortic isthmus (AoI) Doppler flow measurements in intrauterine growth-restricted (IUGR) fetuses with fetal outcome. The data presented in this prospective cohort study were obtained from 74 IUGR and 71 appropriate-for-gestational-age (AGA) fetuses of singleton pregnancies with normal medical and obstetric histories that were between 26 and 40 weeks of gestation. All AoI Doppler scans were performed by the same observer. There were no statistical differences in maternal characteristics and gestational age or between AGA and IUGR fetuses at the inclusion time. No cases of reversed flow during diastole were detected. Aortic isthmus flow index was increased in growth-restricted fetuses. Absolute end-diastolic (EDV) and time-averaged maximum velocities were decreased in the IUGR fetuses. There was an association between AoI Doppler EDV measurements and prediction of neonatal intensive care unit requirement as well as AoI Doppler isthmic flow index and resistance index measurements and low 5-minute Apgar values. Aortic isthmus EDV was found to be independently associated with IUGR status. Because the AoI Doppler flow measurements of the IUGR fetuses were different from the AGA fetuses and predicted neonatal adverse outcome, Doppler imaging of the AoI could be used as a screening tool in the clinical surveillance of fetuses with IUGR after confirmation in larger prospective studies.

Effect of pre-procedural state-trait anxiety on pain perception and discomfort in women undergoing colposcopy for cervical cytological abnormalities.

BACKGROUND: Colposcopy is the gold standard procedure for evaluating cervical cytological abnormalities. Although it is essentially a minimally invasive intervention, referral for colposcopy may cause significant distress on patients. In this study, we aimed to determine if pre-procedural anxiety levels have a significant association with procedure related pain and discomfort in women undergoing colposcopy for evaluation of abnormal cervical cytology. We also assessed the impact of various clinical factors on anxiety, pain and discomfort in these patients. MATERIALS AND METHODS: This prospective study was performed at the Gynecologic Oncology Department of Zekai Tahir Burak Women's Health Education and Research Hospital in Ankara, Turkey between January and June 2013. After taking informed consent, State-Trait Anxiety Inventory (STAI) form and a 14-item questionnaire were filled for women who were admitted to our outpatient colposcopy unit for evaluation of abnormal cervical cytology. STAI scores were calculated for each participant. Immediately after the procedure, visual analog scale (VAS) scores for procedure-related pain and discomfort were obtained. Associations between STAI and VAS scores were investigated using correlation analyses. The effect of various contributing factors on anxiety, pain and discomfort were evaluated with linear regression analysis. The p values less than 0.05 were considered statistically significant. RESULTS: A total of 222 women met the inclusion criteria within the study period. Mean patient age was 38.5±9.6. Median state and trait anxiety scores were 47 and 46, respectively. Median VAS scores for pain and discomfort were 4 for both variables. State anxiety had a significant correlation with procedure related discomfort (p=0.02). Colposcopy related pain VAS scores were significantly affected by state anxiety level, marital status and prior gynecological examination (p<0.05). Colposcopy related discomfort VAS scores were significantly affected by state anxiety level, marital status, prior gynecological examination and educational status. CONCLUSIONS: Additional measures should be implemented in women that carry higher risk for experiencing pain and discomfort. Social, cultural and lifestyle issues may also affect women's experiences during colposcopy, therefore further studies are needed to define specific determining factors in various populations.